This is an Exploratory/Developmental Research (R21) grant application to the National Cancer Institute in response to PAR-02-040 "Pilot Projects in Cancer Complementary and Alternative Medicine." Many children with cancer for whom curative efforts have failed experience substantial suffering in the final months of life. Although high quality palliative care is now an expected standard at the end of life, there are few studies of interventions aimed at symptom reduction and enhanced quality of life for children in palliative care. Pain is a commonly reported symptom for children with terminal cancer, and one of the most overriding and distressing concerns for children and their parents. The current proposal is a combined quantitative and qualitative developmental study with the goal of examining the effectiveness of massage therapy as compared with the application of superficial heat as adjuncts in the control of pain intensity and pain-related negative affect experienced by children with cancer in hospice care. Participants will be estimated by their primary oncologist to be living within their last six months of life. The primary aims of the study are 1) to compare, in a randomized controlled trial, the effects of massage therapy with a thermal control condition (non-human contact physical intervention) on pain intensity and pain-related negative affect during end of life care; 2) to compare pre-post intervention effects within groups; and 3) To examine the acceptability of massage therapy and superficial heat applications to children in home hospice care and their primary caregivers. The secondary aims are 1) to collect preliminary data on potential moderators of treatment response including demographic (e.g., gender, age), medical (diagnosis, time since diagnosis, time in palliative care, symptom-targeted medication), and psychosocial (e.g., expectancies) variables in the two treatment conditions; 2) to assess the ability of children in end of life care to respond to self-report measures of pain; 3) to determine pain intensity and associated affect in children at the end of life; and 4) to provide initial information about the concordance of child-report of pain and parent-report of the child's pain in this patient sample.